To succeed in medicine, try learning 'the rules'
Workplace etiquette and politics, as well as financial savvy, can be just as important as clinical skills
From the October ACP-ASIM Observer, copyright © 2001 by the American College of Physicians-American Society of Internal Medicine.
By William Hoffman
- One key to success: mentors
- Need help building your career? Look to the College's Young Physicians Subcommittee
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When internist and geriatrician Thomas Mulligan, MD, first finished training, he asked his medical director for some pearls of wisdom to help advance his career.
First, the senior physician told him, remember people's names. Second, he said, learn how the system works--and don't try to buck it. He explained that finesse often helps you achieve goals that you otherwise wouldn't reach through confrontation.
"After 30 years, I still use that advice," recalled Dr. Mulligan, who today is professor of medicine at Virginia Commonwealth University's Medical College of Virginia.
It is an important lesson that physicians just starting out often learn the hard way. To get ahead in medicine, you must have more than top-notch clinical skills. You must also learn about negotiation, networking and finance.
"The single biggest pitfall is failing to understand the rules of the game," Dr. Mulligan explained, "and failing to accept them."
While it's true that "the rules" will vary depending on whether you work as a hospitalist, in a private practice or in academia, physicians and career counselors alike say a handful of universal principles can help make your career a success. Here are some of the tips they offered to help young physicians advance their careers.
Learning the ropes
"If you know the rules of the game, you know how to best invest your time and energy," Dr. Mulligan explained. "Yet a lot of junior physicians don't seem to understand them, or when they do, they won't accept them."
How do you identify the rules of your workplace? A good place to start is your workplace's employee handbook, tenure guidelines or other document outlining performance standards.
Many of the rules that govern the working world, however, are more subtle. A good rule of thumb for career success is to do your job well-even if it requires tasks outside your job description.
Dr. Mulligan recalled a promising young doctor on an academic track who was publishing regularly and recognized as a skilled teacher and clinician. When the dean of a medical school asked him to become involved in a relative's care, however, he declined to help.
It was a bungled opportunity that set back the physician's career, Dr. Mulligan said. The doctor failed to realize that everyone above him, not just his direct supervisor, could help or hurt his career.
"Your job is to make your superiors look good," Dr. Mulligan explained. "Never say 'no' to a request for help from above. When you make your superiors look bad, you're making a mistake, and it's going to come back to haunt you." You are also missing an opportunity to make a friend who may help you later, either through mentorship or with support for a promotion. (For more on gaining a mentor, see "One key to success: mentors," below.)
Workplace politics
Workplace politics often get a bad rap, but thinking politically often means simply thinking through the impact of your actions.
Suppose you're a physician working for a health plan and you're considering joining a nascent physician union. You may reap benefits from getting involved in collective bargaining, but you may also hurt your ability to advance in a managed care environment.
Workplace politics do not always have to be negative. Jeffrey S. Krebs, FACP, a partner and general internist at Southern California Permanente Medical Group in San Diego, explained that his organization's 600 members chose their current regional medical director over seven other candidates partly because he earned a reputation for fair, if sometimes unpopular, decision-making.
"Being able to put your ego aside, work with all people and think with clarity will help a lot," said Dr. Krebs, who gives workshops on career and personal financial management. "Those who work well with all people will be able to effectively advance their careers and stay there."
The financial picture
While many physicians would prefer to ignore financial issues and focus on clinical skills, experienced physicians say that stance can lead to problems.
"I've known countless colleagues who have been at clinics that went under or had to make major changes" because of money trouble, explained Linda C. O'Bannon, MD, an internist and medical director for patient management at Aetna Inc. in Chicago. Some of this trouble could be avoided, she said, if physicians in group practices, independent physician associations and clinics were more involved in their organization's financial management.
Learning the basics of how cash flows in and out of your organization can help prevent revenue surprises at the end of the year and at tax time. When you decide to hire a new employee like a nurse practitioner, for example, or add a new procedure, you need to judge the impact of startup costs. You also need to monitor whether a new clinical activity is producing or losing money over time.
Even outside the world of private practice, physicians can benefit by paying attention to their organization's financial matters. Janet E. McElhaney, ACP-ASIM Member, director of the office for the promotion of excellence in research in academia at Eastern Virginia Medical School in Norfolk, Va., suggested finding out where your organization's money comes from and where it goes.
Stephen M. Salerno, FACP, Chair of the College's Young Physicians Subcommittee, said that chatting in the physicians' lounge with colleagues can often produce information you can use. Chances are older colleagues have faced the same problems you're dealing with, whether it's collecting overdue accounts or hiring and firing office staff. Meeting with administrators in your hospital's managed care section may also provide valuable insight.
In an academic setting, find out who has been getting research grants, who lectures at national meetings or who has been promoted. Dr. Salerno, who is assistant residency director at Tripler Army Medical Center in Honolulu, said that by offering to get involved in one of their projects or reading through their research grants, you will better understand the process of gaining resources at your institution. Even if such informal conversations do not produce immediate results, he said, they represent the first step in the important process of networking: making a good first impression.
New skills
Another way to give your career a boost is to develop new skills. Aetna's Dr. O'Bannon said her efforts to become fluent in Spanish have paid off because she can now communicate directly with her Hispanic patients. She noted that foreign language skills can give you a decided advantage at many health care organizations that care for non-English-speaking patients.
In some organizations, you need expertise in disciplines like business administration or finance to get ahead. Dr. Krebs from Southern California Permanente Medical Group noted that most managed care career opportunities come in administrative, management or executive positions.
At Kaiser Permanente, doctors can be elected by their peers to regional boards of directors, which influence call schedules, night-call compensation and doctors' own health benefits. Dr. Krebs said that ambitious young doctors are earning MBA degrees to prepare themselves for these and other opportunities.
To take advantage of the growing demand for physician-administrators, young doctors may also want to consider hospital management opportunities. John G. Self, president and CEO of JohnMarch Partners Inc., a health care management executive recruiter in Tyler, Texas, said that organizations like The Leapfrog Group-which is helping Fortune 500 companies find ways to improve patient care and safety-will increase demand for practicing physicians in administration and management.
"In about 10 years we're going to see a whole crop of executive level physicians who won't be snickered at by administrators who say, 'They're only physicians,'" Mr. Self said.
William Hoffman is a freelance writer in Fairfax, Va.
One key to success: mentors
Experienced physicians say that one key to advancing your career is finding a good mentor.
A number of universities, hospitals and state medical societies offer programs matching mentors with protégés based on mutual interests, temperament and previous mentoring experiences. Typically, however, the younger physician must start the relationship.
"Don't be shy about asking people to lunch, stopping by their offices to meet or talking with them in their spare time," said Marshall H. Chin, FACP, a general internist and associate professor of medicine at the University of Chicago.
Dr. Chin suggested remaining open to all types of physicians when looking for a mentor. "It's sort of like dating," he said. "You don't know how it's going to turn out. You might have to 'date' a lot of people before you find the right one."
Though good mentors usually have wide-ranging experience, Dr. Chin said that they don't necessarily have to work in the same specialty as you. He did note, however, that because frequent contact is crucial to building a mentoring relationship, you should look for someone who works at your institution.
Yank D. Coble, MACP, AMA president-elect and clinical professor of medicine at the University of Florida at Jacksonville, noted that some physicians may need more than one mentor. One mentor might advise you about job opportunities, he said, while another could help you publish.
The College's Young Physicians Subcommittee is looking for physicians with four or more years of post-residency experience to serve as mentors for physicians in their first few years of clinical or academic practice. Volunteer mentors will be listed by state and career next year on the College's Web site. If you are interested in volunteering, contact Jean Elliott at 800-523-1545, ext. 2692, or jelliott@acponline.org.
Need help building your career? Look to the College's Young Physicians Subcommittee
Are you a young internist who's looking for some career help? You're not alone.
All too often, young physicians find themselves on their own once they've finished residency, secured their medical license and accepted their first job. To help address issues important to internists who are just starting out, the College founded the Young Physicians Subcommittee two years ago.
Stephen M. Salerno, FACP, Chair of the Subcommittee and assistant residency director at Tripler Army Medical Center in Honolulu, said that the group was created to help internists under 40 who have completed training start successful clinical and academic careers.
Dr. Salerno said that the Subcommittee serves as a national advisory committee to the College by representing the viewpoints of young generalist and subspecialty internists. The Subcommittee's goal is to ensure that the College provides goods and services of interest to young physicians, fosters involvement in College activities and participates in discussions on changes in health care that affect young physicians.
The Subcommittee has recently created an Adult Preventive Services card, sponsored practice management workshops at Annual Session and provided input about mandatory recertification.
For more information or to get in touch with the Subcommittee, e-mail Dr. Salerno at smsalerno@mindspring.com.
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